Low levels of physical activity have been identified as a major risk factor for cardiovascular disease. However, the evidence for this observation is primarily based on leisure time physical activity. The literature regarding occupational physical activity is controversial. The long-term health effects of different levels of energy expenditure and of different types of activity at work are unknown for most circulatory diseases. However, recent epidemiological research has shown a strong association between prolonged standing at work and hospitalization due to varicose veins, 4-year progression of carotid atherosclerosis, all-cause mortality, and a trend for cardiovascular mortality. The aim of the proposed research is to determine the long-term health effects of different types and levels of occupational physical activity on chronic circulatory diseases. This will be accomplished by an 11-year follow-up of 2682 middle-aged men enrolled in the population-based Kuopio Ischemic Heart Disease Risk Factor Study (KIHD). The KIHD study has the most comprehensive set of biological, behavioral, social, and psychological risk factors of any study, allowing for the control of virtually all known possible confounders. For the first time, the impact of occupational physical activity will be evaluated prospectively on 11-year progression of carotid atherosclerosis and a wide range of specific circulatory diseases, including myocardial infarction, stroke, intermittent claudicating, hypertension, thrombophlebitis, and pulmonary embolism. Specifically, the following questions will be addressed: 1) Is the level of daily energy expenditure during work activities associated with circulatory disease and death? 2) Is the ratio of static/dynamic work predictive of morbidity and mortality? 3) Is a predominantly standing working position a risk factor for arteriovascular and venous diseases? 4) Is the impact of occupational physical activity on persons with existing is chemic heart disease or peripheral vascular disease different from the impact on healthy individuals? The long-term goals of this project are to yield useful information for (1) the primary prevention of chronic diseases of the circulatory system, associated disability, and premature death in the aging working population, and (2) the development of evidence-based recommendations for the optimal balance between static and dynamic work, working postures, and overall levels of occupational and leisure time physical activity, for both healthy people and those diagnosed with cardiovascular disease.